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On the rhythm strip, the QRS might be somewhat taller or wider. One commonly seen type of polymorphic ventricular tachycardia is torsades de pointes. Torsades and other polymorphic VT are advanced rhythms which require additional expertise and expert consultation is advised.
Symptoms of hepatic encephalopathy differ depending on the underlying cause of the liver damage. Symptoms and signs of hepatic encephalopathy may include: difficulty thinking. personality changes. poor concentration. problems with handwriting or loss of other small-hand movements. confusion. forgetfulness. poor judgment.
Cardiogenic shock is a condition in which your heart suddenly can't pump enough blood to meet your body's needs. The condition is most often caused by a severe heart attack. Cardiogenic shock is rare, but it's often fatal if not treated immediately. If treated immediately, about half the people who develop the condition survive.
Phacolytic glaucoma usually is associated with a mature or hypermature cataract and typically occurs in elderly patients. Today, phacolytic glaucoma is rare in the United States, found primarily in areas where access to care is poor. Will the increase in the number of under- and uninsured patients lead to an increase in this condition? Evaluation and Diagnosis Signs and symptoms. Patients typically report acute-onset pain, decreased vision, tearing and photophobia. Examination will reveal injection, corneal edema, elevated IOP, anterior chamber reaction with or without pseudohypopyon, particles on the lens capsule and anterior capsule wrinkling. Patient history. The duration of symptoms should be elicited; a delayed presentation of more than five days since onset can result in glaucomatous disc damage and poorer prognosis.¹ The ocular history may reveal that the patient decided against removal of an advanced cataract. Prior intraocular surgery or trauma may have left residual lens material that could cause phacoanaphylactic glaucoma or exacerbate infectious endophthalmitis. Visual acuity and visual potential should be assessed. Exam essentials. A complete ophthalmologic examination should be done. The eye should be inflamed, and the cornea may be edematous due to the high IOP. The anterior chamber will demonstrate massive inflammation and/ or pseudohypopyon. Gonioscopy is essential; it will help rule out angle closure due to phacomorphic glaucoma or neovascularization of the angle. Assess ment of the posterior pole should be performed to rule out vitreous hemorrhage (which can result in ghost-cell glaucoma) or vitritis (which may be associated with infectious endophthalmitis or panuveitis). If the view to the fundus is obstructed, B-scan ultrasonography also should be performed. Differential diagnosis. The differential diagnosis includes infectious endophthalmitis, phacoanaphylactic glaucoma, inflammatory glaucoma, glaucoma secondary to intraocular tumor, phacomorphic glaucoma, acute-angle closure glaucoma and neovascular glaucoma. Management Medication. Medical management is used to temporarily control the glaucoma and inflammation. Initial treatment consists of hyperosmotic agents, aqueous suppressants, anti-inflammatory drugs and cycloplegics. Surgery. Definitive treatment is removal of the lens via extracapsular cataract extraction with or without an IOL. Some ophthalmologists defer placement of an IOL until after the inflammation subsides; however, there is no significant difference in final visual acuity between those patients who did receive an IOL and those who did not.¹ If the phacolytic glaucoma is of long duration (more than seven days), a combined trabeculectomy may be needed to prevent postoperative IOP spikes.² In eyes with hypermature Morgagnian cataracts, one must be especially careful, as the capsule is fragile, the zonules are weak and the view is difficult due to the white, milky cortex. Vision limited to light perception on presentation is not a contraindication to performing cataract extraction. Surgical Tips For a planned extracapsular cataract extraction with a posterior chamber IOL, fashion a superior fornix-based conjunctival flap.³ Make a partial-thickness incision along the sclerolimbal junction superiorly for 120 degrees with a No. 69 blade. Forty-five degrees away, a paracentesis should be done to decompress the eye. The anterior chamber fluid can be withdrawn for analysis, to look for macrophages and high molecular-weight proteins. Inject balanced salt solution in a cannula to wash out any residual particulate matter, then inject Healon or viscoelastic into the anterior chamber. Make an incision entering the anterior chamber at the 12 o’clock position with a keratome. A 26-gauge cystotome mounted on a syringe is then introduced through the 12 o’clock incision and used to puncture the capsular bag. The milky cortex should be aspirated as much as possible, until the nucleus is visible. Withdraw the needle through the keratome incision, then inject Healon through the 12 o’clock incision into the capsular bag. Next, enlarge the corneoscleral keratome incision with curved Westcott scissors to 120 degrees. Perform a partial V-shaped capsulotomy; this can be done either with the cystotome or with an angled Vannas scissors. Place viscoelastic under the nucleus to float the nucleus and sever any adhesions between the nucleus and the capsule. The nuclear portion of the lens can then be removed with an irrigating vectis (lens loop) with or without gentle pressure at the inferior limbus (6 o’clock). Irrigate and aspirate the residual cortex with the Simcoe cannula. Inspect the capsular bag; if it is intact, place a posterior chamber IOL into the bag. Close the incision with several interrupted 10-0 monofilament nylon sutures and reattach the conjunctival flap. Potential Sequelae and Prognosis Postoperatively, the patient should be managed with topical steroids and/or aqueous suppressants and hyperosmotics if necessary. Vitreous opacification behind the posterior capsule occurs in a small percentage of eyes. These vitreous opacities are typically absorbed by one to two weeks postoperatively. IOP usually is controlled without antiglaucoma medications after the cataract removal. A detailed glaucoma evaluation (including repeat gonioscopy to assess for peripheral anterior synechiae, visual field and optic nerve status) should be done to assess the extent of glaucomatous damage. The prognosis is dependent on the duration of elevated IOP, PAS and optic nerve damage. In one study, patients who were older than 60 and whose glaucoma was present for more than five days did significantly worse than a comparison group of younger individuals with shorter disease duration.
Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side. Signs and symptoms of tonsillitis include swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck. Most cases of tonsillitis are caused by infection with a common virus, but bacterial infections also may cause tonsillitis. Because appropriate treatment for tonsillitis depends on the cause, it's important to get a prompt and accurate diagnosis. Surgery to remove tonsils, once a common procedure to treat tonsillitis, is usually performed only when bacterial tonsillitis occurs frequently, doesn't respond to other treatments or causes serious complications.
Breast lumps facts Breast lumps can be caused by infections, injuries, non-cancerous growths, and cancer. Breast cancer usually causes no pain in the breast. The symptoms of breast cancer include painless breast lumps, nipple discharge, and inflammation of the skin of the breast. The chances that a particular breast lump could be cancerous depends on many factors, including past medical history, physical examination, as well as genetic and other risk factors. The only way to be certain that a lump is not cancerous is to have a tissue sampling (biopsy). There are several ways to do the biopsy. The treatment of a breast lump depends on its cause.
Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized technique used to study the bile ducts, pancreatic duct and gallbladder. Ducts are drainage routes; the drainage channels from the liver are called bile or biliary ducts. The pancreatic duct is the drainage channel from the pancreas.
The easy experimental answer to this question is 264 hours (about 11 days). In 1965, Randy Gardner, a 17-year-old high school student, set this apparent world-record for a science fair. Several other normal research subjects have remained awake for eight to 10 days in carefully monitored experiments. None of these individuals experienced serious medical, neurological, physiological or psychiatric problems. On the other hand, all of them showed progressive and significant deficits in concentration, motivation, perception and other higher mental processes as the duration of sleep deprivation increased. Nevertheless, all experimental subjects recovered to relative normality within one or two nights of recovery sleep. Other anecdotal reports describe soldiers staying awake for four days in battle, or unmedicated patients with mania going without sleep for three to four days.
Ovarian teratoma is a type of germ cell tumour. Germ cell tumours are cancers that begin in egg cells in women or sperm cells in men. There are 2 main types of ovarian teratoma. Mature teratoma, which is benign. Immature teratoma, which is cancerous.
Rheumatic fever is an inflammatory disease that can develop as a complication of inadequately treated strep throat or scarlet fever. Strep throat and scarlet fever are caused by an infection with streptococcus bacteria. Rheumatic fever is most common in 5- to 15-year-old children, though it can develop in younger children and adults. Although strep throat is common, rheumatic fever is rare in the United States and other developed countries. However, rheumatic fever remains common in many developing nations. Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure. Treatments can reduce damage from inflammation, lessen pain and other symptoms, and prevent the recurrence of rheumatic fever.
The following guidelines are an interpretation of the evidence presented in the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations1). They apply primarily to newly born infants undergoing transition from intrauterine to extrauterine life, but the recommendations are also applicable to neonates who have completed perinatal transition and require resuscitation during the first few weeks to months following birth. Practitioners who resuscitate infants at birth or at any time during the initial hospital admission should consider following these guidelines. For the purposes of these guidelines, the terms newborn and neonate are intended to apply to any infant during the initial hospitalization. The term newly born is intended to apply specifically to an infant at the time of birth.
Chronic obstructive pulmonary disease Email this page to a friend Print Facebook Twitter Google+ Chronic obstructive pulmonary disease (COPD) is a common lung disease. Having COPD makes it hard to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus Emphysema, which involves damage to the lungs over time Most people with COPD have a combination of both conditions. Causes Smoking is the main cause of COPD. The more a person smokes, the more likely that person will develop COPD. But some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. Emphysema Other risk factors for COPD are: Exposure to certain gases or fumes in the workplace Exposure to heavy amounts of secondhand smoke and pollution Frequent use of a cooking fire without proper ventilation Symptoms Symptoms may include any of the following: Cough, with or without mucous Fatigue Many respiratory infections Shortness of breath (dyspnea) that gets worse with mild activity Trouble catching one's breath Wheezing Because the symptoms develop slowly, some people may not know that they have COPD.
There are 3 genetic types of FHH based on chromosome location. FHH type 1 accounts for 65% of cases and is due to inactivating mutations in the CASR gene, localized to 3q21.1. This gene encodes the calcium-sensing receptor (CaSR). Loss of CaSR function results in a reduction in the sensitivity of parathyroid and renal cells to calcium levels so hypercalcemia is perceived as normal. The other 35% have either a mutation GNA11 (19p13.3) seen in FHH type 2 or AP2S1 (19q13.2-q13.3) seen in FHH type 3 (see these terms) or in genes not yet discovered. FHH is rarely caused by auto-antibodies against CaSR in those without a mutation.